Journal of Hospital & Medical Management

Fraud and Abuse in U.S. Healthcare: An Evocative Appraisal

Fraud and abuse in U.S. Healthcare system are highly prevalent with colossal cost that accentuates significant burden and influences myriad stakeholders including healthcare providers, the public, patients and their families, healthcare facilities, third party payers and the U.S. government. It is estimated that three hundred billion dollars are lost annually on account of these unethical practices. Additionally, such healthcare malpractices compromise the cost-efficiency and quality of care delivery. Addressing medical fraud and abuse requires a multi-faceted approach blending prevention, detection and legal responses. This descriptive exposition underscores the importance of fraud and abuse in clinical practice, highlighting the key U.S. laws and statutes that are important for healthcare leaders, providers, trainees and administrators. The treatise underscores the necessity for policy makers and leadership in healthcare systems to invest in educating healthcare providers and administrators on laws, policies, compliance programs, adhering to best ethical practices and providing actionable insights toward developing targeted strategies in preventing and combating fraud and abuse.

Author(s): Anish Bhardwaj

Abstract | Full-Text | PDF

Share this